真菌性鼻窦炎课件

《真菌性鼻窦炎课件》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、FUNGALSINUSITISDavidGleinser,MDPatriciaMaeso,MDTheUniversityofTexasMedicalBranch(utmbhealth)DepartmentofOtolaryngologyGrandRoundsPresentationJanuary30,2012IntroductionFungiareubiquitousImmunesystemkeepsorganismssuppressedMostinfectionsarebenign,non-invasiv

2、eImmunocompromised–higherriskofinvasivediseaseNon-invasivevs.invasiveBasicMycology20,000–1.5millionfungalspeciesFewdozenspeciescausehumaninfectionForms:yeastormoldYeastUnicellularReproduceasexuallybybuddingPseudohyphae–whenbuddoesn’tdetachfromyeastMoldMultice

3、llularGrowbybranching–hyphaePseudohyphaevs.HyphaeBasicMycologySporeReproductivestructureproducedinunfavorableconditionsWithstandmanyadverseconditionsFavorableenvironmentgrowthInhalationofspores–mostcommonwayfungiinfiltratesinusestocausediseaseBasicMycologyMi

4、croscopicAppearanceofSpecificFungiAspergillusSeptatedhyphaewithbranchingat45⁰MucromycosisNonseptatedhyphaewithbranchingat90⁰AspergillusNoteseptations(yellowarrows)and45degreebranching(redarrows)Notethe90degreebranchingandlackofseptationsClassificationofInfect

5、ionNon-invasiveSaprophyticfungalinfestationSinusfungalball(mycetoma)AllergicfungalsinusitisInvasiveAcutefulminantinvasivefungalsinusitisChronicinvasivefungalsinusitisGranulomatousinvasivefungalsinusitisSaprophyticFungalInfestationVisiblegrowthoffungusonmucusc

6、rustswithoutinvasionMinimaltonosinonasalsymptomsDiagnosisEndoscopicvisualizationofcrustswithfungiTreatmentRemovalofcrustsNasalsalineirrigationsWeeklynasalendoscopywithremovalofcrustsuntildiseaseprocessresolvesSinusFungalBall(Mycetoma)Sequestrationoffungalelem

7、entswithinasinuswithoutinvasionorgranulomatouschangesInhaledsporesgrowwhileevadinghostimmunesystem(noinvasion)AspergillusmostcommonspeciesMaxillarysinusmostofteninvolved(70-80%ofcases)SinusFungalBall(Mycetoma)ClinicallySymptomsduetomasseffectandsinusobstruct

8、ionPresentssimilartorhinosinusitisCongestion,facialpain,headache,rhinorrheaPhysicalexaminationMildtominimalmucosalinflammationPolypsin10%ofcasesSinusFungalBall(Mycetoma)DiagnosisCTScanSin